Multi-clip applier

ABSTRACT

A clip applier having a handle at a proximal portion, an elongated portion extending distally of the handle, a jaw mechanism including a pair of jaws movable to a closed position to crimp a clip held therein, a clip feeder mechanism movable in proximal and distal directions, a camming mechanism and a puller mechanism movable in proximal and distal directions. The puller mechanism is operatively connected to the handle such that actuation of the handle a) moves the puller mechanism a first distance in the proximal direction; and b) moves the clip feeder mechanism a second distance greater than the first distance.

BACKGROUND OF THE INVENTION

This application claims the benefit of provisional application Ser. No.62/122,406, filed Oct. 20, 2014, the entire contents of which areincorporated herein by reference.

1. Technical Field

The present invention relates to surgical clip appliers embodied as aninstrument having a supply of clips for rapidly deploying several clipsin closing severed blood vessels and other small fluid carrying ducts insurgical procedures.

2. Background of Related Art

There are many different designs for surgical clip applicators for avariety of surgical procedures including both open surgery andlaparoscopy in which a clip applier fits through a trocar tube into abody cavity where the clips are applied.

Current surgical clip appliers include an operating handle and a clipapplying mechanism having an operating cycle in which jaws are squeezedtogether to apply a clip and released. In this operating cycle, a clipis applied to tissue in surgery and the clip applier is reloaded with asingle clip from a clip supply channel for clip application in the nextcycle. The applicator provides a moveable clip supply channel containinga line of clips that are released seriatim.

In U.S. Pat. No. 6,869,435 and 6,423,079, clip crimping jaws apply aclip with a rearward movement of a camming member thereby allowing thefunctions of clip loading and jaw closure to be coordinated and operatedby a single sliding bar moving reciprocally to load and fire clips. Thesupply channel containing the line of clips integrates a clip pusher andan escapement or clip stop spring in a single unit. The clip actuatingmechanism includes a combined actuating rod and in-line clip supplychannel together with clip indexing mechanisms arranged so that with asqueeze of the operating levers, the actuating rod moves rearward in theappliance to apply a clip in surgery, capture the next in-line clip,index a line of clips rearward away from the clip jaws; and that withrelease of the operating levers, the jaws open, the next in-line clip isloaded into the jaws, the second next in-line clip is separated from theline, and the clip indexing movement is reset for the next cycle. Theclip applicator includes a mechanism with minimal complexity especiallysuited for a disposable cartridge for fixed handle appliances. The clipapplicator of the '079 patent also employs low operating force withoutrecoil, a clip counter, jaw lockout after the last clip and is adaptablefor use as a quick snap-in disposable cartridge with a fixednon-disposable operating handle. An operating handle that provideslinear reciprocating motion including scissors-type or pistol grip isused with that invention.

In practice, clip cartridges are ordinarily used a single time anddiscarded. Operating handles, on the other hand, may be disposed ofafter use with a single cartridge, may be used with a plurality ofcartridges in a single surgical procedure and then discarded, or may beautoclaved after each surgical procedure and used over and over again.

This invention in U.S. Pat. No. 6,689,435 provided improvements for arepeating multi-clip applier having a simplified mechanism for applyingclips which mechanism was suitable for the full spectrum of clipappliers including open surgery and laparoscopy. The applier mechanismwas particularly adaptable to the disposable cartridge/fixed handledesign. The simplified mechanism reduced tooling and assemblyrequirements, providing high operating reliability at lower productcost.

The handle stroke for applying clips differs with different clip sizes,i.e., a longer clip requires a longer stroke, This means that adifferent handle needs to be utilized with different size clips. Forexample, a longer clip requires a longer stroke. It would beadvantageous to provide a single handle with a consistent stroke toaccommodate different size clips. This would provide manufacturingadvantages since a single handle design can then be utilized fordifferent size clips. It would also have the advantage in clip applierswith disposable cartridges since cartridges containing different sizeclips could be loaded onto the same handle. This consistent strokeuniversal handle would have application to both open and laparoscopicclip appliers.

Additionally, with the growth of minimally invasive surgery, there is aneed for smaller clip appliers for insertion through smaller accessports, i.e., trocar cannulas, to minimize patient body openings. Inparticular, there is a need for a 5 mm clip applier that could fitthrough a 5 mm trocar. To fit through a 5 mm trocar diameter, severalparameters have to be considered. First, to qualify as a medium clip,the unclosed configuration of the clip must be of sufficient open widthto fit around desired tissue or other structure and have a desiredclosed configuration. Second, the applier needs to be able to beinserted through the cannula without dropping the clip from theinstrument jaws or inadvertently crimping the jaws to close the clip.Additionally, since the width of the jaws exceeds the width of the clip,the jaws need to fit through the 5 mm dimension of the trocar.Satisfying these objectives while still providing a universal handlethat could handle different size clips would be advantageous for thereasons noted above. Thus, it would be advantageous to have a clipapplier that meets the necessary dimensions of insertion through a 5 mmtrocar, i.e., of sufficiently wide width to receive and properly formthe clips but of sufficiently narrow width to pass through the trocardiameter, while ensuring a clip is not formed or lost during insertion,in a handle stroke that can accommodate different clip sizes.

SUMMARY OF THE INVENTION

The present invention in one aspect provides a surgical clip appliercomprising a handle at a proximal portion, an elongated portionextending distally of the handle, a jaw mechanism at a distal portionincluding a pair of jaws movable to a closed position to crimp a clipheld therein, a clip feeder mechanism movable in proximal and distaldirections, and a puller mechanism movable in proximal and distaldirections. The puller mechanism is operatively connected to the handlesuch that actuation of the handle a) moves the puller mechanism a firstdistance in the proximal direction; and b) moves the clip feedermechanism a second distance in the proximal direction, the seconddistance being greater than the first distance.

Preferably, the second distance is twice the first distance. The clipapplier preferably includes a camming mechanism operatively connected tothe puller mechanism to close the jaws to crimp the clip held therein.The clip applier can further comprise to stroke increasing mechanism foreffecting moving of the clip feeder mechanism the second distance andcan include a drive belt. In some embodiments, the drive belt isconnected to the clip feeder mechanism at a first fixation and connectedto the puller mechanism at a second fixation. In other embodiments, theclip feeder mechanism is positioned in a clip magazine, and the drivebelt is connected to the clip magazine at a first fixation and connectedto the puller mechanism at a second fixation. In some embodiments, thefirst fixation and second fixation are on opposite sides of the drivebelt. In some embodiments, the stroke increasing mechanism furthercomprises a first carrier and a second carrier, the drive belt connectedto the first and second carriers, and the second carrier can beoperatively connected to the puller mechanism and the first carrier canbe operatively connected to the first carrier via the drive belt.

In accordance with another aspect of the present invention, alaparoscopic surgical clip applier is provided comprising a handle at aproximal portion, an elongated portion extending distally of the handle,a jaw mechanism at a distal portion including a pair of jaws movable toa closed position to crimp a clip held therein and insertable through atrocar cannula without a clip positioned in the jaws, a puller mechanismoperatively connected to the handle, and a clip feeder mechanism movablein proximal and distal directions, wherein proximal movement of thepuller mechanism effects distal movement of the clip feeder mechanism tofeed a clip into the jaws.

The clip applier preferably includes a stroke increasing mechanism,wherein movement of the handle moves the puller mechanism a firstdistance in a proximal direction to close the jaws and moves the clipfeeder mechanism a second distance in a distal direction, the seconddistance being greater than the first distance. The second distance ispreferably twice the first distance. The puller mechanism effectsproximal movement of a cam mechanism to close the jaws of the jawmechanism. In some embodiments, the stroke increasing mechanism includesa first traveler, a second traveler and a drive belt, wherein movementof the first traveler in a first direction effects movement of the drivebelt to move the second traveler in a second direction opposite thefirst direction. In some embodiments, the drive belt has first loopconnected to the first traveler and a second loop movable along a trackin a housing of the stroke increasing mechanism, and the second travelercan be connected to the clip feeder mechanism and the first traveler canbe connected to the puller mechanism.

In accordance with another aspect of the present invention, alaparoscopic surgical clip applier dimensioned for insertion through afive millimeter trocar cannula is provided comprising a handle at aproximal portion, an elongated portion extending distally of the handle,and a jaw mechanism at a distal portion including a pair of jawsinsertable through the trocar cannula without a clip positioned in thejaws and movable from an open position to a compressed position by thetrocar cannula during insertion through the trocar cannula. The applierfurther includes a puller mechanism operatively connected to the handle,a camming mechanism operatively connected to the puller mechanism andmovable with respect to the jaws to crimp a clip held therein and astroke increasing mechanism, wherein due to the stroke increasingmechanism, movement of the handle moves the puller mechanism a firstdistance and moves a clip feeder a second distance in a reversedirection, the second distance being greater than first distance, andfurther retracts the camming mechanism to close the jaws. Preferably,the second distance is twice the first distance.

In some embodiments, the stroke increasing mechanism includes a firsttraveler, a second traveler and a drive belt, wherein movement of thefirst traveler in a first direction effects movement of the drive beltto move the second traveler in a second direction opposite the firstdirection. In some embodiments, the drive belt has first loop connectedto the first traveler and a second loop movable along a track in ahousing of the stroke increasing mechanism.

BRIEF DESCRIPTION OF THE DRAWINGS

Preferred embodiment(s) of the present disclosure are described hereinwith reference to the drawings wherein:

FIG. 1 is a perspective view of a surgical clip applicator (applicator)of the prior art with location of A-A′ and B-B′ axes.

FIG. 2 is an exploded perspective view of the handle components of thesurgical clip applicator of FIG. 1 including handle subassembly locatingtrigger pivot A-A′ axis, and subassembly of fixed translator, rotarytranslator, anti-backup mechanism, rotatable drum, and thumb wheelaligned on B-B′ axis.

FIG. 3 is a side elevation view of the applicator of FIG. 1 with theoperating handle housing partially in section and with the handle in therelease position.

FIG. 4 is a side elevation view of the applicator of FIG. 1 with theoperating handle housing partially in section and with the handle in thepull (actuated) position.

FIG. 5a is a side elevation of a rotary translator of the surgical clipapplier of FIG. 1.

FIG. 5b is section view taken along line 5 b-5 b of FIG. 5 a.

FIG. 5c is a front elevation of rotary translator of the surgical clipapplier of FIG. 1.

FIG. 6a is a side elevation view of the rotary drum of the clip applierof FIG. 1.

FIG. 6b is a longitudinal section view of the rotary drum of FIG. 6 a.

FIG. 6c is an elevational view of the front face of the rotary drum ofFIG. 6 a.

FIG. 6d is an elevational view of the rear face of the rotary drum ofFIG. 6 a.

FIG. 7 is a front elevation of the anti-backup disc of the clip applierof FIG. 1.

FIG. 8a is a side elevation view of the thumb wheel hub of the clipapplier of FIG. 1.

FIG. 8b is a longitudinal section view of the thumb wheel hub of FIG. 8a.

FIG. 8c is an elevational view of the front face of the thumb wheel hubof FIG. 8 a.

FIG. 8d is an elevational view of the rear face of the thumb wheel hubof FIG. 8 a.

FIGS. 9a-g are sequential views of the anti-backup mechanism of FIG. 7with the disc in (a) rear groove, (b) & (c) between grooves, (d) infront groove, (e) & (f) between grooves, and (g) again in rear groove,and with arrows indicating directions of permitted and preventedmovement of operating handle and cartridge mechanism.

FIGS. 10 a, b, and c are fragmentary perspective views of the sequencefor inserting a clip applying cartridge magazine into a handle assemblyhousing of the clip applier of FIG. 1.

FIG. 11 is an exploded perspective view of the individual cartridgemechanism components of the clip applier of FIG. 1.

FIGS. 12a-b are sequential fragmentary perspective views of the pullerbar/cam puller “lost motion” with related cartridge components.

FIG. 13 is an enlarged section view taken along line 13-13 of FIG. 11.

FIGS. 14 a, b, c, d and e are fragmentary section views of the sequenceof (a) a clip loaded in the jaws ready to fire and clip fired, (b)next-in-line clip being detained, (c) line of clips in cartridge beingindexed rearward, (d) next-in-line clip moved downward into loadingposition, and (e) next-in-line clip loaded into the jaws ready forfiring.

FIG. 15A is an exploded perspective view of the cartridge assembly(mechanism) components of a first embodiment of the present inventionhaving a first embodiment of the stroke doubling assembly (mechanism).

FIG. 15B is an exploded perspective view of one embodiment of a clipapplier having an alternate embodiment of the cartridge assembly(mechanism) and having the stroke doubling assembly of FIG. 15A.

FIG. 15C is a perspective view of the clip applier of FIG. 15B shown inthe open position,

FIG. 16A is a perspective view of the stroke doubling assembly of FIG.15A.

FIG. 16B is a perspective view of the stroke doubling assembly of FIG.15A with one of the body halves removed to show internal components.

FIGS. 17A and 17B are exploded top views from different angles showingthe stroke doubling assembly of FIG. 15A and components of the cartridgeassembly of FIG. 15B.

FIG. 18 is a perspective view with components removed showing the strokedoubling assembly of FIG. 15A mounted within the cartridge assembly.

FIG. 19A is a bottom perspective view of the cartridge assembly of FIG.15B.

FIG. 19B is a top perspective view of the cartridge assembly of FIG.15A.

FIG. 20A is an exploded side view in partial cross-section showing thestroke doubling assembly of FIG. 15A prior to assembly to the cartridgecomponents.

FIGS. 20B and 20C show in side partial cross-sectional views thesequence of operation of the doubling mechanism of FIG. 15A,

FIG. 21 is an exploded perspective view of an alternate embodiment of aclip applier of the present invention having an alternate embodiment ofthe stroke doubling mechanism.

FIG. 22A is an exploded perspective view of the cartridge assemblymechanism) of FIG. 21.

FIG. 22B is an exploded view of components of the cartridge assembly ofFIG. 21,

FIG. 22C is an exploded view of the clip magazine of the cartridgeassembly of FIG. 21.

FIG. 22D is a bottom perspective view of the clip magazine of thecartridge assembly of FIG. 21.

FIG. 23 is an exploded perspective view of certain components of thecartridge assembly and the stroke doubling mechanism of FIG. 21.

FIG. 24 is an exploded bottom perspective view of certain components ofthe cartridge mechanism and the stroke doubling mechanism of FIG. 21.

FIG. 25A is an exploded perspective view of certain components of thecartridge assembly and the stroke doubling mechanism, of FIG. 21 viewedfrom the opposite side of FIG. 23, and the drive belt not shown forclarity.

FIG. 25B is a perspective view similar to FIG. 23 showing the strokedoubling mechanism of FIG. 21 mounted in the chassis.

FIG. 26 is a perspective view of the clip applier of FIG. 21.

FIG. 27A is a perspective view of the handle mechanism of the clipapplier of FIG. 21 with a housing half removed to show internalcomponents, the handle shown in the open position.

FIG. 27B is a perspective view of the handle mechanism of the clipapplier of FIG. 21 with a housing half removed to show internalcomponents, the handle shown in the closed position.

FIG. 28 is an exploded perspective view of the cartridge mechanismcomponents of another embodiment of the present invention having thedoubling/reversing mechanism.

FIG. 29 is an exploded perspective view of the doubling/reversingmechanism of FIG. 28.

FIGS. 30A, 30B and 30C show the sequence of operation of thedoubling/reversing mechanism of FIG. 28.

FIG. 31A is a perspective view of an embodiment of an elongated portionhaving an external and an internal seal of the present invention.

FIGS. 31B and 31C are exploded perspective views of the elongatedportion of FIG. 31A.

FIG. 32 is an exploded view of an alternate embodiment having aninternal seal of the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Referring to the drawings, a repeating multi-clip applier of the priorart corresponding to the clip applier of U.S. Pat. No. 6,869,435 isfirst illustrated and discussed. The present application is animprovement to this clip applier of the prior art by a) increasing astroke to provide a consistent stroke to accommodate different sizeclips and/or b) increasing a stroke and providing a reversing mechanismto enable use with smaller trocar cannulas in laparoscopic surgery. Thefeatures of the improved clip applier and their attendant advantagesfollows the discussion of the prior art clip applier. These features ofthe present invention can be used with the clip applier of the prior artdescribed below or with other clip appliers, such as those describedherein

Prior Art Clip Applier

The clip applier of the prior art is shown in FIGS. 1-14 e and isdesignated generally by reference numeral 10 and includes an operatinghandle housing 12 and a clip applicator cartridge 14 extending from thehousing 12.

The operating handle housing 12 shown in FIGS. 1-4 comprises left 12 aand right 12 b handle members defining a depending grip 12 c, a centersection 12 d defining a central chamber 12 e, and a forward cylindricalportion 12 f defining a forward chamber 12 g. Preferably, the interiordefining surfaces 12 e, 12 g of the right handle member shown in FIG. 2are substantially the same as the corresponding interior surfaces of theleft handle member. The handle members are joined along a mid-plane andtogether receive handle operating components within the central andforward chambers. The handle members define a depending pistol type gripwhich receives a bar spring 16 forming part of the applier mechanism.

A trigger 18 for actuating applier mechanisms is mounted on the housingfor pivotal movement about axis A-A′. The trigger includes a dependinggrip portion 18 a integral with upwardly extending arms 18 b fitted withpivot pins 18 c received in corresponding hubs 12 h located withinhousing central chamber and defining the A-A′ axis. The outer surfaces18 d of the trigger arms are in surface contact with the adjacent innersurfaces 12 m of the housing central chamber so as to confine triggermovement to a smooth circular movement about axis A-A′.

The trigger has a forwardly projecting shoulder 18 e for engaging aplate 12 i affixed to the housing at the central chamber for the purposeof establishing the forward limit of travel of the trigger about axisA-A′ under the force of the bar spring 16 acting through fixedtranslator 20.

The trigger when pulled transmits motion to the clip cartridge mechanism14 a (FIG. 11) through the intermediation of fixed translator slide 20and a rotary translator 22. The trigger cooperates with the fixedtranslator slide 20 to provide reciprocal rectilinear motion ofpredetermined excursion along B-B′ axis, and the fixed translator slidecooperates with the rotary translator 22 to transmit reciprocalrectilinear motion of predetermined excursion and to accommodate 360degree rotation about the B-B′ axis of the rotary translator. In thisway, the actuating mechanism 14 a of the clip cartridge receivesreciprocating rectilinear motion of fixed excursion while the clipcartridge is free to rotate 360 degrees in either direction about theapplicator B-B′ axis.

The fixed translator 20 functions as a slide which determines itscontour. The fixed translator has an elongate body 20 a with dependingleg 20 b having an open slot 20 c defining a drive pin recess, an upperblock 20 d, a spring recess 20 e, and an open front cage 20 f. The fixedtranslator and the trigger form a subassembly with the translatorlocated between the arms 18 b of the trigger, and with the drive pinrecess 20 c fitted over a drive pin 18 f (FIGS. 3, 4) positioned betweenthe trigger arms. The location of the fixed translator between theupwardly extending arms of the trigger helps prevent the trigger armpivot pins from popping out of their A-A′ axis hubs 12 h. When assembledwith the operating handle housing, the fixed translator slides alongcentral chamber surfaces 12 m on either side of the trigger subassembly.The central chamber also accommodates the upper block 20 d which incooperation with the chamber walls limits forward and rearward movementof the trigger/fixed translator subassembly. The upper tip 16 a of thebar spring fits into the spring recess 20 e to provide a forward bias tothe subassembly. So a pull of the trigger against the spring produces acircular trigger motion, i.e., a pivoting motion about axis A-A′, whichis received by the fixed translator as a rectilinear movement ofexcursion fixed by the interior contours of the central chamber and theupper block of the fixed translator. The drive pin recess 20 caccommodates curvilinear movement of the trigger drive pin 18 f andrectilinear movement of the translator. The front cage 20 f of the fixedtranslator has an open front 20 g, interior lip 20 h, and open side 20 ito receive and retain rotary translator 22.

The rotary translator 22 (FIGS. 2, 3 and 5) forms a subassembly with ananti-backup mechanism 24, a rotatable drum 26, and a thumb wheel hub 28which subassembly interconnects the fixed translator 20 and the clipcartridge 14 for performing the functions of transmitting reciprocatingrectilinear motion with a fixed excursion, accommodating rotary motionof the clip cartridge, enabling mounting and disconnecting of the clipcartridge from the operating handle, and providing an anti-backupcapability for the operating handle and cartridge mechanism.

The rotary translator 22 (FIGS. 2, 5) comprises an elongate generallycylindrical shaft 22 a with a rear flange 22 b for connection to thefixed translator cage 20 f so as to accommodate rectilinear motion ofthe rotary translator and fixed translator as a unit, and to accommodaterotary motion of the translator about the B-B′ axis independent of thefixed translator. The center section 22 c of the rotary translator shafthas spaced anti-backup grooves 22 d, 22 e with the distance between thegrooves being approximately equal to the distance of reciprocatingrectilinear motion of the fixed translator and, as becomes clear below,equal to the rectilinear excursion of the clip applicator mechanism. Theintermediate cylindrical surface 22 c of the rotary translatorcooperates with an anti-backup disc 24 described more particularly nextbelow. The rotary translator further includes a front end cage 22 f forconnection to the clip cartridge mechanism 14 a. The front end cage isdefined by a front flange 22 g with a key hole 22 h through its frontface, a set of four interior, longitudinally extending shoulders 22 i,and a pair of knobs 22 k projecting radially from the flange rim. Therotary translator fits within a rotatable drum 26 (FIGS. 2, 6) whichdrum integrates subassembly components.

The rotary drum 26 is in the general form of a cylindrical sleeve 26 afor orientation along the B-B′ axis, with diametrically opposed interiorgrooves 26 b extending the full length of the interior surface 26 c ofthe sleeve, a pair of radially opposed slots 26 d, 26 e extendingthrough the sleeve wall 26 a, an integral wall spring 26 f (FIG. 2)adjacent one of the slots 26 d, a front end flange 26 g, and an enlargedrear end flange 26 h. The front flange includes a key hole 26 j in frontface 26 k.

The rotary drum subassembly 22, 24, 26 comprises the rotary translator22 positioned axially within the drum 26 with knobs 22 k in interiorgrooves 26 b. An anti-backup disc 24 (FIGS. 2, 3 and 7), defined by anopen center 24 a and slots extending radially from the center to definea plurality of inwardly directed spring fingers 24 c, fits onto therotary translator 22 and is assembled to the enlarged rear end flange 26h of the rotary drum by means of a drum cap 26 i. In normal position ofthe clip applicator with the trigger released, the anti-backup springfingers 24 c are located in the rear anti-backup groove as shown in FIG.3.

This rotary drum subassembly is then assembled into the forward chamber12 g of the operating handle housing with drum cap 26 i fitted intochamber recess 12 n (FIG. 2), with the drum front end flange 26 gabutting a front rim of the front chamber, and with the rear flange 22 bof the rotatable translator positioned within the cage 20 f of the fixedtranslator.

A thumb wheel hub 28 (FIGS. 2, 3, and 8) with cylindrical interiorsurface 28 a, tapered fluted exterior 28 b, and front end retaining lip28 c fits over the handle front chamber 12 f in abutment with housingexterior shoulder 12 k and in abutment with the rotary drum front flange26 g.

The rotary drum subassembly within the operating handle housing is nowready to receive the removable clip cartridge and to impart bothreciprocating rectilinear movement to the cartridge and to accommodaterotary movement of the cartridge.

The operation of the anti-backup mechanism is illustrated in FIGS. 9a-g.

As pointed out above, the center section 22 c of the rotary translatorshaft has spaced anti-backup grooves 22 d, 22 e with the distancebetween the grooves being approximately equal to the distance ofreciprocating rectilinear motion of the fixed translator and equal tothe rectilinear excursion of the clip applicator mechanism.

In the mechanism position of FIGS. 3 and 9 a, the handle trigger 18 isin released position with the anti-backup disc 24 in registry with therear anti-backup groove 22 d of the rotary translator 22. When thetrigger is pulled (FIG. 4) (for crimping and applying a clip at asurgical site), the rotary translator moves in the direction of arrow 9a. As the rotary translator continues movement, the spring fingers 24 cof the disc engage the outer surface 22 c of the rotary translator inthe manner shown in FIGS. 9b -c. The anti-backup mechanism applied bythe canted spring fingers 24 c (FIGS. 9b-c ) to the outer surface 22 cof the rotary translator permits continued movement in the direction ofarrow 9 a and prevents movement in the opposite direction of arrow 9 b.If a surgeon releases the trigger with less than a full pull strokeleaving anti-backup components in the position of FIG. 9c , for example,the anti-backup mechanism holds the rotary translator in positionagainst the bias of bar spring 16 which tends to return the trigger torelease position. In this FIG. 9c hold position, the applicator jawsretain the partially crimped clip preventing it from falling into asurgical site. A continuing pull of the trigger (in direction of arrow 9a) moves the rotary translator through the position of FIG. 9c to theposition of FIG. 9d in which the spring fingers 24 c enter the forwardgroove 22 e.

In this position (FIG. 9d ), the rotary translator may now be movedforward (by releasing the trigger and by force of return spring 16) inthe direction of arrow 9 c. In this forward movement, the spring fingers24 c are effective to allow continued forward movement while preventingmovement in the direction of arrow 9 e. If the handle trigger is held bya surgeon with components as in FIG. 9f , the anti-backup mechanism willprevent the surgeon from pulling the trigger in the direction of arrow 9e. The surgeon must allow full release of the trigger to componentposition of FIG. 9g . Direction of movement can be changed again whenthe spring fingers 24 c enter the rear groove 22 e as in FIG. 9 g.

The clip cartridge 14 (FIGS. 10a-c ) includes a tube 14 b with itshandle end having radially projecting positioning pins 14 c emergingfrom end slots 14 d (FIG. 11) in the tube, and an end 14 e (FIG. 12)slot for passing the end of a puller bar 30 while maintaining radialalignment of the pins and puller bar. The puller bar terminates in a Tshape flange 30 a.

Referring to FIGS. 2, 5, 6 and 10 a-c, for assembly of clip cartridge 14and operating handle 12: (a) the clip cartridge 14 is inserted throughkeyhole 26 j into the front end of the rotary drum 26 with cartridgepositioning pins 14 c entering interior drum slots 26 b; (b) the Tflange 30 a projecting through cartridge end slot is in fixed radialorientation in relation to the positioning pins 14 c; (c) the T flangeapproaches end face 22 m of the rotary translator with the T flange inaxial registry with the keyhole 22 h in the front face of cage flange 22f (FIG. 2); (d) the T flange passes through the keyhole 22 h into therotary translator cage 22 f; and (e) the cartridge is rotated (arrow 10a) on B-B′ axis with cartridge pins 14 c entering radial drum slots 26d, 26 e (FIG. 6) and the T flange coming to rest against the rotarytranslator interior cage shoulders 22 i (FIG. 5).

The slot spring 26 f (FIG. 2) engages one of the pins 14 c to hold theclip cartridge in assembled position with the handle.

The cartridge and operating handle are taken apart by reversing theassembly sequence. In this clip applier assembly FIGS. 10a -c, theoperating handle housing 12 may be considered stationary. The rotarydrum subassembly (rotary translator 22, anti-backup mechanism 24 androtary drum) together with thumb wheel hub 28 and the clip cartridge 14are rotatable about the B-B′ axis by manual application of torque to thethumb wheel and with the rear flange 22 b of the rotary translatorrotating freely in fixed translator cage 20 f. In this way the cartridgeis rotatable clockwise and counter clockwise as desired.

A pull on the trigger against the force of bar spring produces unitaryrearward rectilinear movement of the fixed translator, the rotarytranslator passing through the stationary spring fingers of theanti-backup disc, and the puller bar emerging from within the cartridgecasing until the trigger and fixed translator reach the end of traveland with the anti-backup disc spring fingers positioned at the frontgroove. The rearward excursion is now complete, and when the trigger isreleased, the bar spring urges the fixed translator forward until allcomponents reach normal position.

In the event a pull on the trigger is released without reaching the fullextent of rectilinear motion, the anti-back up spring fingers will nothave reached their front groove remaining instead in contact with theouter surface of the rotary translator. The spring fingers in contactwith outer surface function as a brake against the action of the barspring tending to force the released components to return to normalposition. In this partial pull condition of the trigger a clip has beencrimped in the instrument jaws which clip will fall out of the jaws intoa surgical site if the jaws reopen by return of the mechanism to normalposition. So the anti-backup mechanism retains the instrument in“partial pull position” against the normalizing force of the bar springand most importantly prevents fallout from the jaws of a partiallycrimped clip. The anti-backup device retaining action is removed simplyby means of a full pull on the trigger causing the spring fingers toenter the forward groove where they can go “over center” thereafterpermitting the rotary translator to pass through the spring fingers. Itis to be noted that the anti-backup mechanism is effective in bothdirections. The anti-backup mechanism has effect when the trigger isreleased after a full pull so that if there is a “partial release” ofthe trigger, the trigger must nonetheless return to normal position withfull release of the trigger before allowing the trigger to be pulled.The design requirement for full release achieved by the anti-backupmechanism prevents double loading of clips into cartridge jaws.

It is a further aspect of the anti-backup mechanism that the cartridgemay be rotated on the B-B′ axis as the anti-backup mechanism holds theinstrument in partial pull position enabling a surgeon to adjustcartridge or jaw position even after a partial pull has occurred.

The clip cartridge 14 FIGS. 11-14 a-e comprises an applicator housingtube 32, upper cartridge shell 34 and lower cartridge shell 36 connectedto the operating handle housing as described above. The applicatorhousing upper 34 and lower 36 shells are elongate open ended channelshaving locating pins 14 c serving to connect the cartridge to the handleas described above. The channels together define the end slot 14 e (FIG.12) through which the puller bar end 30 a extends into the operatinghandle. The clip applicator housing encloses and forms part of a clipapplicator mechanism 14 a. In the following description, the applicatorhousing upper and lower shells 34, 36 are regarded as stationary inrelation to movement of the applicator mechanism components.

The lower cartridge shell 36 has an anchor pin 36 a affixed to thechannel base interior 36 b. The lower cartridge shell receives a campuller bar 38 and coil spring 38 a for sliding movement, and clipapplicator jaws 40 mounted on the anchor pin 36 a. The cartridge pullerbar 30 overlies the cam puller bar 38.

The elongate cartridge puller bar 30 is located in the applicator lowershell 36 c with the bar connected at its T shape rear end 30 a to therotary translator for receiving linear reciprocating motion with respectto the stationary lower shell 36 for each cycle of the handle operatingtrigger. The cartridge puller bar toward its front end includeslaterally extending tabs 30 b which cooperate with the cam puller bar38. The cartridge puller bar also has a round hole 30 c for receiving amagazine pin 42 a depending from the underside of a clip magazine 42 bywhich the cartridge puller bar actuates the clip magazine. The magazinepin also passes through an elongate slot in a stationary clip plate 41.

The cam puller 38 occupies the lower shell beneath the cartridge pullerbar and the clip applicator jaws. The cam puller bar is fitted withupstanding cooperating cam members 38 b for closing and opening the clipapplicator jaws 40. The cam puller bar includes a rear tang 38 c andcoil spring 38 a accommodated in a recess 36 b in the lower shell. Thecam puller further includes an anchor pin slot 38 d to accommodatereciprocal movement of the cam puller past the anchor pin 36 a in thebase channel and a cartridge pin slot 38 e for accommodating movement ofthe cam puller past the cartridge pin 42 a fitted to the underside ofthe clip supply magazine. The cam puller is fitted with spaced sets ofupwardly extending tabs 38 f and 38 g for cooperating with the cartridgepuller bar lateral tabs 30 b.

The cam puller 38 is urged by coil spring 38 a toward the forward end(i.e., the jaws end) of the clip cartridge so as to leave the clipapplicator jaws 40 normally open. The cartridge puller bar 30 isnormally forward under the influence of the handle bar spring withpuller tabs 30 b abutting the forward set of cam puller tabs 38 f. Whenthe trigger handle is pulled (FIG. 12a ), the cartridge puller bar 30moves rearward (with lost motion or dwell between cam puller bar forward38 f and rear 38 g tab sets) until the cartridge puller tabs 30 b engagethe rear set 38 g of cam puller tabs thereby drawing the cam puller 38to the rear against its coil spring for closing the applicator jaws. Thecartridge pin slot 38 e accommodates cam puller movement past thecartridge channel pin 42 a during the time of lost motion between thecartridge puller bar 30 and cam puller tab sets 38 f-g.

Lost motion of the cam puller bar ensures that the applicator jawsremain open for a portion of the rearward movement of the cartridgepuller bar before the jaws close and crimp a clip in surgery. It isdesirable to crimp the clip at the end of rearward travel so as toprovide the surgeon with a natural feel for releasing the handle. Lostmotion also has significance on the forward stroke of the clipapplicator mechanism by ensuring the applicator jaws are open to receivea clip during the forward stroke of the applicator mechanism, as is tobe fully understood with description of the clip supply magazine andassociated mechanisms below.

Clip applying jaws 40 comprising spring biased arms 40 c-d are mountedat opening 40 e to anchor pin 36 a on the applicator lower shell withthe jaws projecting from the front end of the base channel.

FIGS. 11 and 12 a-b illustrate spring biased applicator jaws affixed tothe applicator housing anchor pin 36 a with spring biased arms 40 c-dable to move from open-to-closed-to-open positions in applying a clip.The inner surfaces 40 f of the jaws are recessed to form cooperatingchannels for movement of each clip into the jaws. The outer surfaces ofthe jaws have aligned recesses 40 b and inclined cam surfaces 40 gcooperating with aligned cam members 38 b affixed to the cam puller forthe purpose of closing the jaws for each rearward excursion of thecartridge puller bar 30. The jaws are released to spring open on theforward excursion of the cam puller placing the cam members within therecesses 40 b. The normal position for the cam puller 38 and jaws 40occurs with the cam puller at the forward end of linear excursion, withthe jaws open and with the cam puller cam members 38 b in an inactiveposition with respect to applicator jaws as in FIG. 12 b.

The cartridge applicator mechanism includes a clip supply magazine 42(FIGS. 11, 13 and 14 a-e) which is affixed to and reciprocates with thecartridge puller bar 30 by means of magazine pin 42 a at the undersidethe magazine fitting into hole in the puller bar. The clip supplymagazine and cartridge puller bar are separated by a stationary clipplate 41 having a central slot 41 a to accommodate sliding movement ofthe clip supply magazine 42 and its pin 42 a by means of the cartridgepuller bar. The clip plate 41 includes a cam slot 41 b and front endclip ramp 41 c cooperating with the clip supply channel as describedbelow.

The clip supply magazine 42 (FIGS. 11, 13) includes an elongate baseplate 42 b with upstanding sides 42 c to define a central channel 42 dfor receiving and retaining a line of clips C. A dome 42 e extendsbetween the sides for receiving an elongate clip follower 42 f and coilspring 42 g. The clip follower is positioned and retained in the clipsupply magazine in engagement with the last clip C.sub.Z (FIG. 14) andis urged forward by the coil spring for advancing the line of clipsalong the supply channel. The clip follower has forwardly directedfingers 42 h for engaging clip shoulders for constantly maintaining aforce on the line of clips by means of the coil spring.

The clip supply magazine 42 (FIG. 11) has an integral forwardlyextending pusher plate 42 i preferably with notched front edge 42 hconforming to clip contour for the purpose of pushing each clip into thejaws as it leaves the supply magazine.

A clip stop spring 42 k (FIGS. 11, 14) with vertical tip 42 m is formedintegral in the base plate 42 b of the clip magazine for gripping theleading clip C.sub.L at midpoint. The clip stop spring has a “springset” wherein the spring is normally positioned or biased below thesurface 42 n of base plate (as in FIG. 14a ) with the spring beingaccommodated in the cam slot 41 b (FIGS. 11 and 14) of stationary clipplate 41 located underneath the magazine.

The clip plate 41 is fixed to the stationary housing by suitable meansso that the back edge of the cam slot 41 b urges the clip stop spring 42k and its tip upward into the path of clips C when the clip magazinemoves rearward with the cartridge puller bar (FIGS. 14a-c ). As notedabove, the slot 41 a in the clip plate accommodates reciprocal movementof the clip magazine/puller bar connecting pin 42 a.

The housing upper shell 34 has depending from its inner surface a clipdetent spring 44 (FIGS. 11, 14) and a guide ramp surface 34 a forpositioning clips for movement into clip applying jaws. The clip detentspring comprises a leaf spring 44 a with spaced depending panels 44 b-cof identical edge contour terminating in forwardly directed notches 44 dfor engaging the shoulders of a lead clip C.sub.L to separate the leadclip from the line as the line of clips and the clip magazine are pulledrearward by clip stop spring 44 k and cartridge puller bar 30 with apull of the operating trigger. On release of the trigger and consequentforward movement of the clip magazine (FIGS. 14d-e ), the cartridgepusher plate 42 i engages the rear surface of the detained lead clipC.sub.L and pushes it into the crimping jaws.

The action of clip moving components is shown in FIGS. 14a-e startingwith FIG. 14a which shows components in forward position and a clipC.sub.J in the instrument jaws.

Referring to FIG. 14a , a first in line of clips C.sub.F is at restunder the detent spring notches 44 d for the purpose of separating clipC.sub.F. The detent spring 44 is stationary in that it is affixed to theunder side of the housing cover in position to capture and hold the leadclip C.sub.F at the end of the forward excursion of the cartridge pullerbar and clip supply magazine. The detent spring takes and separates thelead clip C.sub.F from the clip line in preparation for movement of thelead clip into the applicator jaws on a subsequent applicator cycle. Thedetent spring separates clip C.sub.F by reaction as the inclined rearedges ride up (FIG. 14e ) on forwardly moving clip C.sub.F and snap down(FIG. 14a ) as the clip passes the shoulders. Such clip capture occursas the puller bar and clip magazine reciprocate during operation of theapplicator, as detailed below.

From the position of FIG. 14a , a rearward pull of the trigger beginsimmediate rearward sliding movement of clip supply magazine 42 withrespect to stationary upper shell 42 and stationary clip plate 41. Theclip detent spring 44 holds and separates clip C.sub.F from the line ofclips. The line of clips moves rearward with the clip cartridge as clipstop spring 42 k is cammed upward (FIG. 14b ) by cam slot 41 b in clipplate 41. As movement continues (FIG. 14c ), the cartridge pusher plate42 i also moves rearward sliding underneath clip C.sub.F and coming torest behind the clip (FIG. 14d ) at the end of the rearward stroke ofthe operating handles. As pusher plate 42 i slides behind clip C.sub.F,the clip detent spring 44 (having a normal downward spring force) pushesclip C.sub.F downward into contact with clip ramp 41 c. When theoperating handles are released, beginning from the position of FIG. 14dand continuing to FIG. 14e , the clip cartridge pusher plate 42 iengages clip C.sub.F, pushes it forward between upper shell ramp surface34 a and clip plate ramp 41 c and on into the instrument jaws. As thisforward motion occurs, the clip detent spring 44 rides up on clipC.sub.L with notches 44 d coming to rest behind the clip shoulder asillustrated in FIG. 14 a.

The operation of clip applicator is as follows. The housing upper andlower shells are stationary with respect to movements of the componentparts of the actuating mechanism. At the beginning of an operating cycle(or normal position), the handle trigger is in forward or releaseposition, the cartridge puller bar and clip supply magazine are inforward position, the jaws are open holding a clip in position forsurgical application, jaw actuating cam puller is in inactive position,the lead clip is in the capture position under clip detent spring, thecartridge pusher plate lies under the captured lead clip, the clip stopspring is inactive and lies in the clip plate cam slot below the surfaceof the pusher plate, the spring loaded clip follower engages the last inline clip, and the spring biased line of clips is in contact with leadclip C.sub.F.

By squeezing the trigger, the puller bar and clip magazine move rearwardrelative to the stationary upper and lower shells and stationary clipplate to accomplish:

a. movement of the magazine pusher plate out of the jaws,

b. continued movement of the pusher plate relative to the clip platewhereby the stop spring is cammed up so its tip grips the next in lineclip C.sub.L and by continued rearward movement the stop springseparates the clip stack from the lead clip C.sub.F;

c. after an initial lost motion or dwell phase during which the jaws areopen, engagement of cartridge puller bar tabs and cam puller tabs forpulling cams means along jaw cam surfaces to close the jaws and crimp aclip in surgical application,

d. the captured clip C.sub.F is held in place under the clip detentspring;

e. movement of the cartridge pusher plate from underneath captured clipC.sub.F into position behind clip C.sub.F;

f. downward movement of clip detent spring and clip C.sub.F on to theclip plate ramp and in front of the clip pusher plate; and by releasingthe trigger, the cartridge puller bar and clip supply magazine moveforward in relative movement to the stationary upper and lower shellsand stationary clip plate to accomplish:

g. disengagement of the cartridge puller bar tabs from the cam pullertabs and forward movement of the cam puller bar under the influence ofits coil spring thereby moving cam means along the jaws cam surfacesinto inactive position thereby opening the jaws;

h. movement of the cartridge pusher plate to advance the captured clipC.sub.F into the jaws; and

i. the cartridge pusher plate and stop spring move relative to the clipplate with the stop spring reentering its slot in the clip plate out ofthe path of the clip line so as to permit the next in line clip C.sub.Lto advance along the surface of the pusher plate to deflect the clipdetent spring and be captured as C.sub.F.

The clip applicator of FIG. 2 can be made as a disposable cartridge tobe inserted into a non-disposable handle with the cartridge removed fromthe handle and discarded after its clips are consumed. In a cartridgearrangement both the cartridge housing and rear end of the actuating rodhave plug-in connections to the handle housing and link journalrespectively.

The magazine pusher plate acts as a lock-out of the jaws after all theclips in the cartridge magazine have been used and there are none left.Such lock-out action occurs as the pusher plate without a clip to pushitself enters the space between the crimping jaws and prevents the jawsfrom closing thereby indicating to the surgeon that there are no moreclips to be applied.

Clip Appliers of the Present Invention

The present invention provides improvements to the aforedescribed clipapplier of the prior art by providing a stroke increasing mechanism. Thestroke increasing mechanisms/assemblies of the present invention can beutilized with the prior art clip applier of FIGS. 1-14, the other clipappliers disclosed herein or with other clip appliers.

There are two variations of the clip applier of the present inventionwhich provide unique advantages. In one aspect, a mechanism is providedto increase a stroke, e.g., a doubling of the stroke, to provide aconsistent handle stroke. This enables the same handle, i.e., auniversal handle, to be used to apply different size clips, e.g., amedium clip (5.03 mm width/5.02 mm height) or a medium large clip (e.g.,4.50 mm width/8.00 mm height). In the absence of such mechanism, since adifferent stroke is necessary to apply a different sized clip, e.g., aclip of longer length, a different handle mechanism would be requiredfor each size clip. Thus, this feature has manufacturing advantages,e.g., reduces overall manufacturing costs since a single type handle canbe manufactured for applying different size clips. This also provides anadvantage where a reusable handle and a disposable cartridge aredesired. In the absence of such uniform handle, different handles wouldneed to be manufactured and stocked by the user to accommodate differentsize clips, i.e., one handle for firing a series of clip of one size andanother handle for firing a series of clips of another size. With theuniform consistent-stroke handle of the present invention, only onehandle need be manufactured or stocked. This stroke doubling is achievedby the /belt system described in detail below. Various embodiments ofthis aspect are illustrated in FIGS. 15A-27B.

In another aspect of the present invention, providing an improvementover prior art clip appliers, a mechanism is provided which not onlyincreases a stroke, e.g., a doubling of the stroke, to provide aconsistent handle stroke but reverses the clip feeder movement so a clipis not fed into the jaws until after insertion of the clip applierthrough the trocar cannula. Thus, this universal handle can be used withclip appliers insertable through small trocars, e.g., a 5 mm trocar.This is achieved by providing a mechanism that keeps a clip out of thejaws during initial insertion of the clip applier through a trocar andloads the clip in the jaws after it is inserted through the trocar.Thus, the size of the clip, e.g., a medium or medium large clip, can bemaintained even though the applier is inserted through a smaller trocar.Further, by loading the clip after insertion, the risk of crimping theclip during insertion or the clip becoming dislodged is eliminated,adding a safety advantage. Additionally, by providing a handle strokewhich loads a clip and closes the jaws, the clip applier can be removedthrough the trocar before all clips are fired since in the normalposition, a clip is not positioned in the jaws. Such design for use witha smaller trocar, without sacrificing clip performance, is achievedthrough the doubling/reversing belt system described in detail below.This aspect is shown in FIGS. 28-30C.

Turning first to FIGS. 15-20, a first embodiment of the strokeincreasing mechanism (or stroke increasing assembly) is illustrated.Preferably, the mechanism (assembly) effects a doubling of the stroke sothe mechanism of this embodiment is also referred to herein as thestroke doubling mechanism. However, it should also be appreciated thatother increases in stroke are also contemplated and within the scope ofthe present invention to achieve the objectives of the presentinvention.

The embodiment of FIG. 15A is identical to the embodiment of the priorart of FIGS. 1-14 except for the doubling mechanism and relatedcomponents. Therefore, for brevity only the differences are discussed indetail. For convenience, like components to clip applier 10 of FIGS.1-14 have been numbered in FIG. 15A in the “100 series” so thatcorresponding parts can readily be appreciated. For example, thecartridge components of FIG. 15A include an applicator housing tube 132identical to tube 32 (forming an elongated portion), a clip detentspring 144 identical to spring 144, an upper shell 134 identical toshell 34, a clip follower 142 f and coil spring 142 g identical to clipfollower 42 f and coil spring 42 g, respectively, a stationary clipplate 141 identical to clip plate 41, jaws 140 identical to jaws 40 andcam or camming mechanism 138 biased by coil spring 138 a identical tocam 38 and spring 38 a to close the jaws 140 upon proximal movement.These components are not discussed in more detail herein since theirstructure and function are identical to the structure and function ofthese components of FIGS. 1-14. Additionally, other features such as thehandle, anti-backup mechanism, etc. are not shown since they areidentical to that of FIG. 1-14 and their description with respect tothose Figures is fully applicable to the embodiment of FIG. 15A. FIG.15A differs from the embodiment of FIG. 1-14 in the provision of thestroke doubling mechanism 50, also referred to herein as the strokedoubling assembly. Due to provision of the stroke doubling mechanism 50,the clip supply magazine 63, cam puller bar or puller mechanism 65 andlower cartridge shell 67 differ from these components of clip applier 10of FIGS. 1-14 and therefore are not numbered in the “100 series” and arediscussed in detail below in conjunction with doubling assembly 50. Thestroke doubling mechanism 50 results in proximal movement of the campuller 65 a distance X effecting a proximal movement of the clip feeder(or clip magazine) a distance 2×. As noted above, the second distanceneed not be 2×but can be other multiples of, or increases to, x.

The doubling mechanism 50 can also be used with other cartridgemechanisms such as that shown in FIG. 15B and 15C. The cartridgemechanism of FIG. 15B operates in a similar fashion to the cartridgemechanism of FIG. 15A however some of the components are different. Forexample, the cartridge mechanism of FIG. 15B has a cover 202 and achassis 224 which are assembled together forming an elongated portion ofthe instrument extending distally form the handle assembly 226.Positioned within the assembled cover 202 and chassis 224 are a clippusher 206 biased by spring 208 for advancing the stack of clips 210, aclip detent 204 to engage and separate the lead clip, a clip track floor212 to support the clips 214, a clip advancer or mechanism 216 toadvance a lead clip 214 into jaws 217 of jaw mechanism 218, and a cam orcamming mechanism 220 attached to a cam puller bar 222 or pullermechanism for proximal movement to cam the jaws 217 to a closedposition. Note although the puller bar or puller mechanism 222 is shownas a bar, alternatively it could be shaped as a rod as in the embodimentof FIG. 21. Note the angle of the cam and jaws can be that disclosed inpending application Ser. No. 14/756,281, filed Aug. 20, 2015, the entirecontents of which are incorporated herein by reference. The handleassembly 226 for actuating the cartridge components is shown in FIGS.15B and 15C with the stationary handle or grip designated by referencenumeral 230 and the movable handle to effect clip application andadvancement designated by reference numeral 228. Squeezing of movablehandle 238 effects retraction of puller bar 222 which effects retractionof clip feeder (advancer) 216 and retracts cam 220 to close the jaws217. Release of the movable handle 238 to return to its original openposition effects distal movement of puller bar 222 to its originalposition and distal movement of clip advancer 216 to its originalposition as described in detail below along with the discussion of thestroke increasing mechanism 50. Rotation knob 232 can be provided torotate the elongated portion and/or cartridge to change the position ofthe jaws 217 of jaw mechanism 218. Other handle mechanisms, includingthose described below can also be utilized. The cartridge assembly canbe permanently attached to the handle for a single use or alternativelyit can be a separable and disposable cartridge, replaceable by anothercartridge, for multiple uses in a single procedure. The strokeincreasing mechanisms disclosed herein enables replacement of cartridgeswith different sized clips.

It should be appreciated that these cartridge mechanisms of FIGS. 15Aand 15B are shown by way of example as other cartridge mechanisms, e.g.,with variations of the illustrated components, can be configured toaccommodate the unique stroke increasing mechanisms of FIG. 15A-20C.

Turning now to the stroke increasing mechanism (also as noted abovereferred to herein in conjunction with the illustrated embodiment as thestroke doubling mechanism), and with reference to FIGS. 16A-19B, thedoubling mechanism 50 has an outer body 51 having a proximal portion 52a, a distal portion 52 b, a distal lower mounting tab 54 b and aproximal lower mounting tab 54 b. Outer body 51 can be composed of twobody halves 51 a, 51 b as shown in FIG. 17. Note the terms “lower” and“upper” as used herein are with respect to the orientation shown in thedrawings. Clearly, if the orientation changes, the reference to upperand lower would also change. The stroke doubling mechanism 50 results inproximal movement of the cam puller a distance X effecting a proximalmovement of the clip feeder (or clip magazine) a distance 2×. As notedabove, the second distance need not be 2×but can be other multiples of,or increases to, X.

Doubling mechanism 50 further includes a drive belt 72, arranged formovement in a longitudinal (axial) direction within the cartridgemechanism. The drive belt 72 is preferably a flexible high tensile lowfriction belt. Drive belt 72 has a top engagement member 72 a, e.g. aferrule 72 a, and a bottom engagement member 72 b, e.g., a ferrule 72 b.The ferrules 72 a, 72 b are attached to the belt 72. Although shown asferrules, other engagement or fixation mechanisms or members are alsocontemplated. The belt 72 has a proximal looped portion 73 a and adistal looped portion 73 b looped around respective proximal and distalround supports 76 a, 76 b (FIG. 17A) forming a track for travel of thebelt 72. The body 51 has a proximal channel 74 a and a distal channel 74b to provide space for the drive belt 72 and enable movement of thedrive belt 72. A longitudinally extending elongated rib 75 extends frombody half 51 a and is received in a corresponding slot (not shown) inbody half 51 b for alignment and fastening. When the two body portions51 a, 51 b are assembled they form a channel or recess 53 to accommodatemovement of the belt 72.

The doubling mechanism 50 is mounted within the chassis 224 and engagesboth the clip advancer 216 and the cam puller bar 222. Morespecifically, in the embodiment of FIG. 15B, the chassis 224 has a firstpair of tabs 225 a and a second pair of tabs 225 b as shown in FIG. 17A.Lower ferrule 72B is mounted between tabs 225 a, 225 b. Proximal anddistal mounting tabs 54 a, 54 b fit within slot 222 a of cam puller bar222 to operatively connect doubling mechanism 50 to the cam puller bar222. Lower ferrule 72 b also extends through slot 222 a in cam puller222 for mounting in the lower positioned chassis 224. Lower mounting tab54 b is positioned proximal of tabs 225 a. Upper ferrule 72 a ispositioned within slot 216 a of clip advancer 216 of the clip magazineto operatively connect the doubling mechanism 50 to the clip advancer216. In this manner, the doubling mechanism 50 operably connects the campuller 222 which effects closure of the jaws 217 (by camming mechanism220) and the clip advancer 216 which advances clips 214 into the jaws217.

In the embodiment of FIG. 15A in which the cartridge components aredifferent but the doubling mechanism is the same, the doubling mechanism50 (of FIGS. 16A and 16B) is mounted to the lower shell 67 viaengagement of the lower ferrule 72 b within slot 67 a for fixation tothe lower shell 67. Upper ferrule 72 a engages a slot in the clipmagazine 63 (or alternatively a clip advancer of the clip magazine) tooperatively connect the doubling mechanism 50 to the clip advancer.Lower mounting tabs 54 a, 54 b are mounted within slot 65 a of pullerbar 65 to operatively connect the doubling mechanism 50 to the campuller bar 65 to effect closure of jaws 140 by camming mechanism 138. Inthis manner, the doubling mechanism 50 operably connects the cam pullerbar 65 which effects closure of the jaws 140 by camming mechanism 138and the clip magazine 63 which advances a clip into the jaws 140.

The operating sequence of the doubling mechanism 50 will now bedescribed in reference to FIGS. 20A-20C which show in cross-section thecartridge components of FIG. 15B which interact with the doublingmechanism 50. FIGS. 20A and 20B show the initial position of thecomponents, which corresponds to the clip applier handle being in theopen or at rest position, such as the position of FIG. 15C (or FIG. 1).FIG. 20A shows an exploded view (pre-assembly) and FIGS. 20B and 20Cshows the components assembled. Note as assembled, the lower beltfixation member, e.g. lower ferrule 72 b, is positioned within tabs 225a, 225 b of the chassis 224 and the upper belt fixation member, e.g.ferrule 72 b, is engaged within slot 216 a of the clip advancer (feederbar) 216. The lower mounting tabs 52 a, 52 b fit within slot 222 a ofthe puller bar (puller mechanism) 222. When the handle 228 is actuated(squeezed), e.g., moved toward stationary handle 230, the cam puller 222is retracted and a doubling of the proximal movement of the clipadvancer 216 is effected as shown in FIG. 20C due to the movement of thebelt 72. For example, if the cam puller bar 222 is retracted about 0.500inches, the clip advancer 216 is retracted about 1.000 inches. That is,ferrule 72 b in chassis 224 remains stationary, however, as the campuller bar 222 moves rearwardly (proximally) a first distance withrespect to the chassis 224, it induces proximal movement of the body 51and belt 72 around rounded ends 76 a, 76 b along the track within body51, thereby causing the upper fixation member 72 a to pull the clipadvancer 216 rearwardly a second increased (doubled) distance due to itsengagement within slot 216 a. After sufficient retraction of the campuller 222, i.e., near the end of the handle stroke, e.g., with 0.250″remaining in the stroke, the cam puller 222 engages the cammingmechanism (cam bar) 220 to retract the camming mechanism 220 to cam thejaws 217 to crimp (close) the clip 214 held within the jaws 217 aroundthe target structure. This delay prior to puller mechanism 222 engagingthe camming mechanism 220 is achieved by a slot and pin arrangementwhereby the slotted camming mechanism 220 or puller mechanism 222 slidesone over the other until it contacts an appropriately spaced stop on theother member resulting in the camming mechanism 220 and puller bar 222continuing to move (retract in unison) After such retraction, the handle228 is returned to the initial positon, with the puller mechanism 222moving distally carrying the clip advancer 216 distally and the cammingmechanism 220 distally returning to their initial position to move thejaws 217 back to the open position and feed a clip 214 into the jaws217, the clip advancer 216 traveling twice the return (distal) distanceas the cam puller 222, for subsequent squeezing of the handle 228 toapply the next clip. Note that when the engagement point of the cammingmechanism 220 has been reached, it is released, allowing the jaws 217 tobias to an open position to receive a clip. The remainder of the strokeallows the clip feeder to advance a fresh clip into the open jaws.

Note the sequence of operation is the same for the embodiment of FIG.15A, with the handle effecting proximal movement of the cam puller bar65 which moves the body 51 of the doubling mechanism 50 and the belt 72to pull back the clip magazine 63 (and clip advancer) an increased,e.g., doubled, distance and retract camming mechanism 138, and releaseand return of the handle returns the cam puller 65, camming mechanism138 and clip magazine (and clip advancer) distally to the originalposition.

An alternate embodiment of the doubling mechanism is shown in FIGS.21-27B and is designated generally by reference numeral 80. Theembodiment of the cartridge mechanism of FIGS. 21-22D is similar in manyrespects to the embodiment of the cartridge of FIG. 15B and operates inmany respects similar to the embodiment of FIGS. 1-14, but includes thedoubling mechanism 80. Therefore, for brevity only the doublingmechanism 80 is discussed in detail since the clip applier otherwiseoperates in a similar manner as the foregoing embodiments. The cartridgecomponents of FIGS. 21-22C include a sleeve tube 256, a cover 258 andchassis 274 which are assembled together and positioned within thesleeve tube 256, thus forming an elongated portion extending from handle280. Contained within the assembly are a clip magazine 260 containing aline of clips 290, a detent spring 262 to engage and separate the leadclip, a clip floor 264, a jaw mechanism 265 having a pair of jaws 266, acam or camming mechanism 268 for closing the jaws 266 upon proximalmovement, a cam puller rod or puller mechanism 270 for pulling the cam268 to effect jaw closure, and a toggle lock 272 identical to the togglelock disclosed in commonly owned co-pending patent publications2013/0165951 and 2014/0379003, the entire contents of which areincorporated herein by reference. As in the aforedescribed embodiments,cam puller 268 is pulled proximally to close the jaws 266 to effectclosure of the clip positioned within the jaws 266 and a clip feederwithin clip magazine 260 feeds a clip into the jaws 266. Clip magazine260 includes a magazine cover 284, a row of clips 290 biased distally bya clip pusher 288 and spring 286, and a magazine base 294 with distalspring 292. The magazine base 294 has a slot 296 (FIG. 22C) to receive afixation member of the doubling mechanism 80 as described below. Theclip applier 250 also has a handle portion 280 having two handle bodyhalves 280 a, 280 b, anti-backup ratchet 287 with spring 288 and pawl290, engaging teeth in the rack of ratchet 287, disclosed in applicationSer. No. 14/121,344, filed Aug. 22, 2014, the entire contents of whichare incorporated herein by reference. Movable handle (trigger) 284effects jaw closure and clip pusher movement upon movement towardstationary handle 282. The handle 280 is shown in the open position inFIG. 27A and in the closed position in FIG. 27B. Rotation knob 276 canbe provided to rotate the elongated portion and/or cartridge to changethe position of the jaws. Other handle mechanisms, including thosedescribed herein can also be utilized with the doubling mechanism 80.Additionally, the cartridge assembly can be permanently attached to thehandle for a single use or alternatively it can be a separable anddisposable cartridge, replaceable by another cartridge, for multipleuses in a single procedure. Note the doubling mechanism 80 can also beused with the cartridge mechanisms of FIGS. 15A and/or FIG. 15B or withother cartridge mechanisms to achieve its objectives.

Turning now to the doubling mechanism 80 and with reference to FIGS.23-25B, the doubling mechanism 80 includes a high tensile low frictiondrive belt 82, a first traveler or carrier 84 and a second traveler orcarrier 86. The drive belt 82 loops around rounded supports 87 a, 87 bof traveler 86 and has two looped ends 82 a, 82 b each extending into arespective leg 82 c, 82 d transverse to the longitudinal axis andextending downwardly (as viewed in the orientation of FIG. 23) so thebelt 82 can more easily be tightened during manufacture. The legs 82 c,82 d can then be trimmed (not shown) for the final assembly.

The traveler 84 has a mounting tab 84 a extending upwardly whichconnects to a slot 260 a in clip magazine 260 (FIG. 22D). Thisoperatively connects the doubling mechanism 80 to the clip magazine 260.Note in alternate embodiments the tab 84 a can connect to a clip feederwithin the magazine 260 where the clip feeder reciprocates within themagazine rather than the entire magazine. Traveler 84 also has atransverse tab 84 b (FIG. 25A) with a longitudinal slot formed thereinto receive drive belt 82.

As noted above, traveler 84 b has proximal and distal rounded ends 87 a,87 b around which belt 82 travels, forming a track. Ends 86 a, 86 b oftraveler 86 have a slot for mounting to recesses or slots 270 a, 270 bof puller rod 270. This operatively connects the doubling mechanism 80to the cam puller rod (camming mechanism) 270. The puller rod portion270 c between slots 270 a, 270 b extends through recess 86 c in traveler86. Note that although as shown as a puller rod, a flat plate as inother embodiments disclosed herein could be utilized.

Travelers 84 and 86 are mounted within a recess 274 a in the chassis274, with traveler 84 alongside a distal region of traveler 86. The legs82 c, 82 d of belt 82 can extend through opening 274 b in chassis 274(FIG. 24)

The sequence of operation of the doubling mechanism 80 is similar tothat of doubling mechanism in that a drive belt is used to increase,e.g. double, the distance of travel of the clip magazine (and clipfeeder) compared to the distance of travel of the cam puller. In use,actuation of the handle 280 by squeezing movable handle (trigger) 284from the position of FIGS. 26 and 27A retracts the puller rod 270(mounted within fixed chassis 274) proximally. Due to the engagement oftraveler 86 within slots 270 a, 270 b of the puller rod 270, suchmovement retracts the traveler 86 and moves the drive belt 82,retracting the traveler 84, thereby pulling the operatively connectedclip magazine 260 proximally due to the engagement of tab 84 a oftraveler 84 within slot 260 a of magazine 260. This results in the clipmagazine 260 retracting a second distance which is twice the firstdistance of retraction of the puller rod 270 with each handle stroke.After sufficient retraction of the cam puller (puller mechanism) 270,i.e., near the end of the handle stroke, the puller rod 270 engagescamming mechanism 268 to move it proximally as they move back in unison.After such retraction, the handle 280 is returned to the initialpositon, with the cam puller rod 270, cam 268, and clip magazine 260returning to their initial position to move the jaws 266 back to theopen position and feed a clip into the jaws 266, the clip magazine 260traveling twice the return (distal) distance as the cam puller rod 270,for subsequent squeezing of the handle 284 to apply the next clip ofclip row 290.

FIGS. 31A to 32 illustrate embodiments of an instrument seal that can beutilized. Such seal can be utilized with any of the embodimentsdisclosed herein. As noted above, cover 258 and chassis 274 areassembled together, forming an assembly 275, and positioned within asleeve tube, such as sleeve tube 256 or FIG. 22A. A plurality of annularO-ring seals 277, e.g., three O-rings, are axially spaced along theassembly 275 formed by cover 258 and chassis 274, and sit within thesleeve tube which slides over the assembled cover/chassis, therebyproviding a pneumatic seal between the assembly 275 and sleeve tube toprevent leakage of insufflation gas through the clip applier. To providea seal within the assembly, a viscous sealant is injected through port279 (or alternatively, multiple ports), in the cover 258 of theassembled unit. The sealing grease exits a second port 279 a in thechassis 274 to indicate full capacity. The grease thus fills the bodysurrounding puller rod 270. The grease also encircles the assembly,filling the groove or reduced diameter portion 279 b between O-rings277. In the alternate embodiment of FIG. 32, the chassis 274 and cover250, when assembled, form a first sealing grease compartment 281 a and asecond grease compartment 281 b (or alternatively multiple compartments)to surround the reciprocating puller bar 259, thereby preventing passageof gas through the clip applier. When filled to capacity through port279, the grease overflowing compartment 281 a flows to compartment 281b.

FIGS. 27-30 illustrate an embodiment of the stroke increasing andreversing mechanism of the present invention. The clip applier of thisembodiment is especially designed for laparoscopic surgery and forinsertion through a 5 mm diameter trocar cannula, although it can beutilized with trocar cannulas of other dimensions. The clip applierconfiguration and components enable insertion through such smallertrocar without sacrificing necessary clip size. It also reduces the riskof formation of a clip or dislodgement of a clip from the jaws duringinsertion through the trocar cannula. This is all achieved in a reducedcost manner and with a universal handle that can also be used to applydifferent sized clips. To this effect, the jaws are biased to an openposition, inserted without a clip in the jaws, and compressed to aclosed position when inserted. Squeezing of the handle advances thedistalmost clip into the jaws and the advancer then instantly andbiasedly retracts after which continued retraction of the pullerretracts the camming mechanism to close the jaws. This action isperformed in a single continuous proximal stroke of the handle. Thisstructure has the advantages of insertion without a clip in the jaws andmaintaining the jaws in a normal position without a clip (until thehandle is activated) so the clip applier can be removed through thetrocar before all clips are fired if so desired since there would be noclip in the jaws and the jaws could compress through the trocar cannuladuring withdrawal.

The clip applier is similar in many respects the embodiment of FIG. 15A(which is similar to the embodiment of the prior art of FIGS. 1-14),however, it has a doubling/reversing mechanism (assembly). Therefore,for brevity only the differences are discussed in detail. Forconvenience, like components to clip applier 10 of FIGS. 1-14 have beennumbered in FIG. 28 in the “300 series” so that corresponding parts canreadily be appreciated. For example, the cartridge components of FIG. 28include an applicator housing tube 332 identical to tube 32. The housingtube 332 extends distally from a handle portion (similar to theaforedescribed handle portions) to form with other components a distallyextending elongated portion. Within the housing tube 332 are a clipdetent spring 344 identical to spring 44, an upper shell 334 identicalto shell 34, a clip follower 342 f and coil spring 342 g identical toclip follower 42 f and coil spring 42 g, respectively, a stationary clipplate 341 identical to clip plate 41, jaws 340 identical to jaws 40 andcam or camming mechanism 338 biased by coil spring 338 a identical tocam 38 and spring 38 a to close the jaws 340 upon proximal movement.These components are not discussed in more detail herein since theirstructure and function are identical to the structure and function ofthese components of FIGS. 1-14. Additionally, other features such as thehandle, anti-backup mechanism, etc. are not shown since they areidentical to that of FIG. 1-14 and their description with respect tothose Figures is fully applicable to the embodiment of FIG. 15A. FIG. 28differs from the embodiment of FIG. 1-14 in the provision of the strokeincreasing and reversing mechanism 420, also referred to herein as thestroke doubling/increasing assembly. Due to provision of thedoubling/reversing mechanism 420, the clip supply magazine 402, pullerbar (pulling mechanism) 404 and lower cartridge shell 406 differ fromthese components of clip applier 10 of FIGS. 1-14 and therefore are notnumbered in the “300 series” and are discussed in detail below inconjunction with doubling/reversing assembly 420. The stroke doublingmechanism 420 results in proximal movement of the puller mechanism 404 adistance X effecting a distal movement of the clip feeder (oralternatively a clip magazine) a distance 2×. As noted above, the seconddistance need not be 2×but can be other multiples of, or increases to,X.

It should be appreciated that the doubling/reversing mechanism 420 canalso be used with other cartridge mechanisms such as that shown in FIG.15B, 15C and 22A and is shown for use with the cartridge of FIG. 28 byway of example.

Preferably, the mechanism (assembly) effects a doubling of the stroke sothe mechanism of this embodiment is also referred to herein as thestroke doubling mechanism. However, it should also be appreciated thatother increases in stroke are also contemplated and within the scope ofthe present invention to achieve the objectives of the presentinvention.

Turning now to the doubling/reversing mechanism (assembly) and withreference to FIG. 29, the assembly 420 includes a body composed of ahousing 421 and a cover plate 422 connected to housing 421. The housing421 and cover plate 421 have a recess 421 b, 422 b, respectively toprovide a gap or slot when assembled. The body is fixed within the lowercartridge shell 406 as the traveler 428 moves within the fixed body, andslot 404 b accommodates the body. Contained within the housing 421 is adrive belt 440, a first traveler or carrier 426 and a second traveler orcarrier 430. The first traveler 426 has a pair of transverse wings ortabs 428 extending therefrom which connect to the puller bar 404 whicheffects closure of the jaws 341 of jaw mechanism 340 upon sufficientretraction in a proximal direction. Thus, first traveler 426 isoperatively connected to the cam puller 404 to provide reciprocatingmotion of the cam puller 404. Traveler 430 has an upwardly extending tab432 (as viewed in the orientation of FIG. 29) with an opening 434 toreceive the end of the drive belt 440. The traveler 430 is operativelyconnected to the clip magazine 402 (or clip advancer) to effect movementof the clip advancer 402. Drive belt 440 is preferably a flexible hightensile low friction belt. Drive belt forms a first larger loop 441 anda second smaller loop 444. As seen in FIG. 29, belt 440 can be viewed asstarting at leg 442 a, extending in a first direction, looping at loop443 to extend in the opposite (second) direction, then looping back atloop 445, extending upwardly into a fixation point or engagement 446,extending back in the first direction, looping at loop 448 to extendback in the second direction to transition into loop 449 where it loopsback in the first direction terminating at leg 442 b. Legs 442 a, 442 bare fixed within tab 432 of traveler 430. Housing 421 has rounded ends424 a, 424 b which the larger loop 441 of drive belt 440 extends as itfollows the track within housing 421. The shorter loop 444 extendsaround traveler 426. Housing 421 includes a slot 421 a through which oneof the wings 428 of traveler 426 extend. The other wing extends throughslot 422 a in cover plate 422.

The sequence of operation will now be described with reference to FIGS.30A-30C. In the initial position of FIG. 30A, traveler 430 is engagedwith clip advancer (clip feeder bar or mechanism) 402 via engagement oftab 432 with slot 402 a of clip advancer 402. Traveler 426 is engagedwith cam puller bar (puller mechanism) 404 via attachment of wings 428with ears 404 a of cam puller 404. Note traveler 426 is in a distalposition. As discussed above, belt 440 is attached to traveler 430 viasecurement of legs 442 a, 442 b within mounting tab 432. Upon squeezingof the handle (proximally), such as the handle 284 or other handlesdisclosed herein, cam puller bar 404 is retracted proximally (the bodyremains stationary as it is fixed to lower shell 406), thereby pullingtraveler 426 proximally. This causes movement of belt 440 which advancestraveler and connected clip feeder 402 distally as shown in FIGS. 30Band 30C which show movement through a complete (full) handle stroke. Ascan be appreciated, due to belt 440, movement of cam puller bar 404 afirst distance A, e.g., about 0.50 inches, effects the reverse (distal)movement of clip feeder 402 a greater second distance B, e.g., about1.000 inches, thereby effecting a doubling of its movement. Suchmovement pushes a clip into the jaws 340. When the clip reaches fullengagement, a trip mechanism releases the clip advancer to return it toa biased proximal position. The continuation of the proximal handlestroke causes the puller mechanism 404 to engage the camming mechanism338 to retract the camming mechanism 338 to close jaws 340. This alloccurs (clip advancer movement and camming mechanism movement) in acontinuous proximal stroke of the handle trigger. When the handle isreleased, the cam puller 404 returns distally to its initial position ofFIG. 30A to move the camming mechanism 338 distally to its initialposition; the clip feeder has already returned proximally to its initialposition of FIG. 30A (due to the trip mechanism) in preparation forapplication of the next clip by subsequent squeezing of the handle. Notedistal handle release returns the jaws to a clipless state. This enableswithdrawal of the clip applier if no more clips are required to beapplied. Note that FIG. 30B illustrates an intermediate position forease of explanation as preferably the handle stroke is a smoothcontinuous (uninterrupted) stroke to effect movement of the componentsfrom the position of FIG. 30A to the position of FIG. 30C. Note also ananti-backup ratchet such as that described above prevents accidentalrelease of the clip from the jaws prior to complete closure of the jaws.

Various changes may be made to the structure embodying the principles ofthe invention. The foregoing embodiments are set forth in anillustrative and not in a limiting sense. The scope of the invention isdefined by the claims appended hereto.

What is claimed is:
 1. A surgical clip applier comprising: a handle at aproximal portion; an elongated portion extending distally of the handle;a jaw mechanism at a distal portion, the jaw mechanism including a pairof jaws movable to a closed position to crimp a clip held therein; acamming mechanism; a clip feeder mechanism movable in proximal anddistal directions; and a puller mechanism movable in proximal and distaldirections, the puller mechanism operatively connected to the handlesuch that actuation of the handle a) moves the puller mechanism a firstdistance in the proximal direction; and b) moves the clip feedermechanism a second distance in the proximal direction, the seconddistance being greater than the first distance.
 2. The clip applier ofclaim 1, wherein the second distance is twice the first distance.
 3. Theclip applier of claim 1, wherein the camming mechanism is operativelyconnected to the puller mechanism and movement of the puller mechanismretracts the camming mechanism to close the jaws to crimp the clip heldtherein.
 4. The clip applier of claim 1, further comprising a strokeincreasing mechanism for effecting moving of the clip feeder mechanismthe second distance, the stroke increasing mechanism including a drivebelt, and the drive belt is connected to the clip feeder mechanism at afirst fixation and a connected to the puller mechanism at a secondfixation.
 5. The clip applier of claim 3, wherein the clip feedermechanism is positioned in a clip magazine, and the drive belt isconnected to the clip magazine at a first fixation and connected to thepuller mechanism at a second fixation.
 6. The clip applier of claim 4,wherein the first fixation and second fixation are on opposite sides ofthe drive belt.
 7. The clip applier of claim 4, wherein the strokeincreasing mechanism further comprises a body encapsulating the drivebelt, the body fixedly mounted to a chassis of the clip applier.
 8. Theclip applier of claim 4, wherein movement of the puller mechanism movesthe drive belt to effect movement of the second fixation of the drivebelt to move the clip feeder mechanism in the proximal direction.
 9. Theclip applier of claim 4, wherein the stroke increasing mechanism furthercomprises a first carrier and a second carrier, the drive belt connectedto the first and second carriers.
 10. The clip applier of claim 9,wherein the second carrier is operatively connected to the pullermechanism and the first carrier is operatively connected to the firstcarrier via the drive belt.
 11. A laparoscopic surgical clip appliercomprising: a handle at a proximal portion; an elongated portionextending distally of the handle; a jaw mechanism at a distal portion,the jaw mechanism including a pair of jaws movable to a closed positionto crimp a clip held therein, the jaw mechanism insertable through atrocar cannula without a clip positioned in the jaws; a puller mechanismoperatively connected to the handle; a camming mechanism operativelyconnected to the puller mechanism for proximal movement to close thejaws; and a clip feeder mechanism movable in proximal and distaldirections, wherein proximal movement of the camming mechanism to closethe jaws effects distal movement of the clip feeder mechanism to feed aclip into the jaws.
 12. The clip applier of claim 11, further comprisinga stroke increasing mechanism, wherein movement of the handle moves thepuller mechanism a first distance in a proximal direction to move theclip feeder mechanism a second distance in a distal direction, thesecond distance being greater than the first distance.
 13. The clipapplier of claim 12, wherein the second distance is twice the firstdistance.
 14. The clip applier of claim 12, wherein proximal movement ofthe puller mechanism after a dwell period effects proximal movement of acamming mechanism to close the jaws of the jaw mechanism.
 15. The clipapplier of claim 11, wherein the stroke increasing mechanism includes afirst traveler, a second traveler and a drive belt, wherein movement ofthe first traveler in a first direction effects movement of the drivebelt to move the second traveler in a second direction opposite thefirst direction, wherein the second traveler is connected to the clipfeeder mechanism and the first traveler is connected to the pullermechanism.
 16. The clip applier of claim 14, wherein the drive belt hasfirst loop connected to the first traveler and a second loop movablealong a track in a housing of the stroke increasing mechanism.
 17. Alaparoscopic surgical clip applier dimensioned for insertion through afive millimeter trocar cannula comprising: a handle at a proximalportion; an elongated portion extending distally of the handle; a jawmechanism at a distal portion, the jaw mechanism including a pair ofjaws insertable through the trocar cannula without a clip positioned inthe jaws and movable from an open position to a compressed position bythe trocar cannula during insertion through the trocar cannula; a pullermechanism operatively connected to the handle; a camming mechanismoperatively connected to the puller mechanism and movable with respectto the jaws to crimp a clip held therein; and a stroke increasingmechanism; wherein due to the stroke increasing mechanism, movement ofthe handle moves the puller mechanism a first distance to move a clipfeeder a second distance in a reverse direction, the second distancebeing greater than first distance, and further retracts the cammingmechanism to close the jaws.
 18. The clip applier of claim 17, whereinthe second distance is twice the first distance.
 19. The clip applier ofclaim 17, wherein the stroke increasing mechanism includes a firsttraveler, a second traveler and a drive belt, wherein movement of thefirst traveler in a first direction effects movement of the drive beltto move the second traveler in a second direction opposite the firstdirection.
 20. The clip applier of claim 17, wherein the drive belt hasfirst loop connected to the first traveler and a second loop movablealong a track in a housing of the stroke increasing mechanism.